HomeMy WebLinkAboutPermit Plumbing 2004-6-16
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~, CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
, PERMIT NO: COM2004-00692
ISSUED: 06/16/2004
APPLIED: 06/11/2004
EXPIRES: 12/16/2004
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4774 Rocky Rd Springfield TYPE OF WORK: Plumbing Only
ASSESSOR'S PARCEL NO.: ROCKY RD SUB LOT 11
TYPE OF USE:
New
Residential
PROJECT DESCRIPTION: 60' Storm Sewer Line
Owner: PACIFIC WEST ENGINEERING, INC
Address: 3610 GOOD PASTURE LOOP EUGENE OR 97401
Phone Number: 541-344-2215
I CONTRACTOR INFORMATION I
Contractor Type
Contractor
License
Expiration Date Phone
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy'Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
. I DEVEt~~~NT INFORMATION'
~\~ "\\'\ \S ~ \
Frontyard Setback: ' \... 't.i-?\~ ?'t.~~\h;flay Dist:
, Side 1 Setback: -f.\C~' :\ S\\~\,; ~ \\\\S ~\J~'t.\#'Street Trees Rqd:
Side 2 Setbaclt\\) \ ~~~\ '0~\)\::. ~~~~ Paved Drive Rqd:
Rearyard Setbl\.~S \' \J~\1~\> \J~ \S ~ ' % of Lot Coverage:
Solar Setbacks: ~'0\~ ,,(..~\;'t.\> o't.~\C) .
\JJ.~"I\~\) 'Jf~ '\ '" 0~iI''' a~f(\~
Street Improv.m.::.i \ I PUBLIC I:::VE~~~~~~~~:~~~\
.',.,;,.;;;'Y' \~O"'" l.'\'j.~)."'.",,'\,o~ ,~n f..~n,,,"1,B ~'r:5",:-:I.\'-O:~
Storm,Sewer Available: "...~ ~I'r "... .~WQ~~~n~4J.dS
SpecialInstruction: ~,-er,i~~ 0\ au.\' 0.0':) \J.. \Crsv () \}O. tt-O\\O\
, \)~~0u.00~u.\ \0 S~~O~~ C\. '~0\\}~-e S0\~ ~~~~
l~ S0\~~ \:)~O ~~~ rasOU. 90\0.09 .~O\":J
I" ('o,f\.1.F)'O ,.,,-e S0~ ou\ f..o. l,'Ora~O .
I . ~o~-.;...... of/::" I 0~ tt-"O\ -
V aluation ~,~ . ~
" 0\
$ Per Sq Ft' Square Footage
or multiplier or Bid Amount
REQUIRED PARKING
Total:
Handicapped:
Compact:
Notes:
Description
Type of Construction
Value
Date Calculated
Total Value of Project
Pa2e 1 of2
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2004-00692
ISSUED: 06/16/2004
APPLIED: 06/11/2004
,EXPIRES: 12/16/2004
VALUE:
._{i,~B!~~~l"'~f' ,., "_
~ '
~
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-:726-3676 Fax
541-726-3769 Inspection Line
I Fees Paid I
Fee Description
+ 10% Administrative Fee
+ 7% State Surcharge
Storm Sewer - 1st 50 Feet
Storm Sewer Each Addt1100'
Amount Paid
Date Paid
$5.90
$4.13
$45.00
$14.00
6/16/04
6/16/04
6/16/04
6/16/04
Total Amount Paid
$69.03
I Plan Reviews I
Receipt Number
2200400000000000782
2200400000000000782
2200400000000000782
2200400000000000782
To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
will be made the same working day, inspections requested after 7:00 a.m. will be made the following work
day.
I Reouired Insoections .
Storm Sewer Line: Prior to filling trench.
By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. '
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the
street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
:ZZ;7~/!!~
\
.Q.wneLor Contractors Signature
~G!:12-
Date
t;'-/A --()tJ-
Pae:e 2 of 2
225 Fifth Street
. ..
SpriIigfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-00688
COM2004-00688
COM2004-00688
COM2004-00688
COM2004-00689
COM2004-00689 '
COM2004-00689
COM2004-00689
COM2004-00689
COM2004-00689
COM2004-00689
COM2004-00690
COM2004-00690
COM2004-00690
COM2004-00690
COM2004-00690
COM2004-00691
COM2004-00691
COM2004-00691
COM2004-00691
COM2004-00692
COM2004-00692
COM2004-00692
COM2004-00692
RECEIPT #:
Description
Storm Sewer - 1st 50 Feet
Storm Sewer Each Addtl J 00'
+ 7% State Surcharge
+ 10% Administrative Fee
Sanitary Sewer - 1st 50 Feet
, Sanitary Sewer Each Addtl 100'
Storm Sewer - 1st 50 Feet
Storm Sewer Each Addtl 100'
Fixture
+ 7% State Surcharge
+ 10% Administrative Fee
Fixture
Storm Sewer - 1st 50 Feet
Storm Sewer Each Addtl 100'
, + 7% State Surcharge
+ 10% Administrative Fee
Fixture
Storm Sewer - 1st 50 Feet
+ 7% State Surcharge
+ 10% Administrative Fee
Storm Sewer - 1st 50 Feet
Storm Sewer Each AddtlIOO'
+ 7% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment Paid By
Check
6/16/2004
DAVID NICHOLS
iJ~~~~,'!i,'"!:fl", <~,,""-,",,",,',',l,.
La.," --._--'''.~,.-''~ ,I
~~J""
"'~'-""',..,...'~ ,..,"~
r:..v of Springfield Official Receipt
lelopment Services Department
Public Works Department
2200400000000000782
Date: 06/16/2004
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb
1462
In Person
Payment Total:
Page 1 of 1
8:55:16AM
Amount Due
45.00
14.00
4.13
5.90
45.00
14.00
45.00
14.00
28.00
10.22
14,60
14.00
45.00
14.00
5.11
7.30
14.00
45.00
4.13
5.90
45.00
14.00
4.13
5.90
$463.32
Amount Paid
$463.32
$463.32